Application for Department of Defense Impact Aid for Children with Severe Disabilities

Forms and Documents

Document Name	Status
Form SD 816 SD 816/816C Form	Modified
0704-0425_SSA_3.4.2020.docx Supporting Statement A	2020-03-04
0704-0425_Sample Award Letter.docx Supplementary Document	2020-02-24
0704-0425_Initial Email Notification to LEAs.docx Supplementary Document	2020-02-24

IC Document Collections

IC ID	Document Title	Status
5521	SD 816/816C Form	Modified

ICR Details

OMB Control No: 0704-0425	ICR Reference No: 202001-0704-001
Status: Active	Previous ICR Reference No: 201705-0704-001
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Application for Department of Defense Impact Aid for Children with Severe Disabilities
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/13/2020
	Date Received in OIRA: 03/04/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	36 Months From Approved	06/30/2020
Responses	50	0	50
Time Burden (Hours)	400	0	400
Cost Burden (Dollars)	14,650	0	14,700

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Abstract: Department of Defense funds are authorized for local educational agencies (LEAs) that educate military dependent students with severe disabilities and meet certain criteria. The application will be requested of LEAs that educate military dependent students to determine if they meet the criteria to receive additional funds from the Department of Defense due to the high special education cost of the military dependent students with severe disabilities that they serve.

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Authorizing Statute(s): US Code: 20 USC 7703a Name of Law: Impact aid for children with severe disabilities
   PL: Pub.L. 106 - 398 363 Name of Law: The National Defense Authorization Act for Fiscal Year (FY) 2001
   PL: Pub.L. 447 - 92 572 Name of Law: The National Defense Authorization act for FY 2016
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 61043	11/12/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 6536	02/05/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
SD 816/816C	SD 816, SD 816c	Application for Department of Defense Impact Aid for Children with Severe Disabilities ,   Application for Department of Defense Impact Aid for Children with Severe Disabilities (continuation page)

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	50	50	0	0	0	0
Annual Time Burden (Hours)	400	400	0	0	0	0
Annual Cost Burden (Dollars)	14,650	14,700	0	-50	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $22,800

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/04/2020

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